Claims service—how efficient and proactive is your carrier partner?

Author: Sean Cooley, Symetra Regional Group Manager

In earlier posts we explored how the stop loss market continues to evolve and things to look for in a stop loss contract. Another important factor to consider when evaluating potential stop loss carriers is claims experience.


Some questions to ask:


  • Does the carrier have 100% claim authority for reimbursements to your clients? Or, do they first require authorization from their reinsurer before a claim can be paid? Stop loss carriers often purchase reinsurance for several reasons—the most common being to mitigate their liability on catastrophic claims (those exceeding $2 million).
  • How many days does the carrier average for claim reimbursements?
  • Does the carrier offer true advance funding of claims in excess of the specific deductible to facilitate cash flow for your clients? If so, is this advance funding available for the duration of the contract, including the last 30 days of the policy?
  • Are your clients able to find out—in advance of a reimbursement request—how the carrier will reimburse a stop loss claim? This could help the employers clarify their intended Plan Document coverage for experimental/investigational treatments or procedures involving new technologies.

An experienced carrier with knowledgeable claims staff and efficient processes will help ensure your clients’ self-funded plans work as intended.

Stay tuned for our next post as we close out this series with underwriting practices. Is the policy renewal-friendly?